Atarax (Hydroxyzine) in Spain: What It Treats and Who Should Avoid It

Atarax is a prescription medicine containing hydroxyzine (hidroxizina), a drowsy antihistamine. In Spain it eases itching in adults and children from 12 months, and anxiety symptoms in adults. This guide is by Dr. Pedro Yelamo Vera, an English-speaking GP licensed in Spain (Colegiado No. 484814280) who sees patients by video in English and Spanish.

What is Atarax used for?

Atarax is used to relieve the symptoms of itching and of anxiety. The Spanish product information lists two uses:

• itching (pruritus) in adults, teenagers and children from 12 months;
• anxiety symptoms in adults over 18.

It eases symptoms. It does not cure the cause of the itch, such as eczema, hives or a skin infection. That is why a doctor looks for the cause first.

Is Atarax good for itching?

Yes, easing itch is one of its two approved uses. Doctors may choose it when itching keeps you awake, because it causes drowsiness. For daytime itch from allergies, a non-drowsy antihistamine is often tried first.

What is Atarax 25 mg?

"Atarax 25 mg" is the name of the tablet product: Atarax 25 mg comprimidos recubiertos con película. The number is the strength of each tablet. It is not advice on how much to take. Your dose is set by your prescription and explained in the leaflet. The tablets contain lactose, so mention lactose problems to your doctor.

What is Atarax syrup?

Atarax jarabe is the liquid form, sold as Atarax 2 mg/ml jarabe. The leaflet says the syrup may suit children better, as young children may not be able to swallow tablets. It is not approved for babies under 12 months. The syrup contains sugar (sucrose), which matters for people with diabetes or rare sugar intolerances.

Can Atarax be used for anxiety?

Yes, in adults, but only after a doctor has assessed you. A doctor first asks about your symptoms, your heart and your other medicines, then decides if any medicine is needed. Atarax only eases symptoms, for the shortest time possible. It is not a quick fix, and it is not a substitute for talking therapy or longer-term treatment.

Is Atarax a sleeping pill?

No. Sleep problems are not an approved use in Spain. Drowsiness is a side effect, not its purpose. This practice does not prescribe controlled medicines, such as benzodiazepines or sleeping pills, by video. Hydroxyzine is not one of them, but it is also not prescribed online just to help you sleep.

Why are there safety limits on hydroxyzine?

In 2015 the Spanish medicines agency (AEMPS) and the EU limited its use because it can change the heart rhythm. Hydroxyzine can lengthen the QT interval, a measure on a heart tracing (ECG). Rarely, this leads to a dangerous fast rhythm. The rules since then are:

• use the lowest dose that works, for the shortest time possible;
• do not use it in people with a long QT interval or risk factors for one;
• avoid it in older adults; if it is really needed, they get a lower dose;
• take extra care with medicines that lower potassium or slow the heart.

Who should not take Atarax?

Do not take Atarax, and tell your doctor, if you:

• are allergic to hydroxyzine, cetirizine or similar medicines (piperazines), aminophylline or ethylenediamine;
• have porphyria;
• have a long QT interval, from birth or acquired;
• have heart disease, a very slow heartbeat, or low potassium or magnesium in the blood;
• have a family member who died suddenly from a heart problem;
• take another medicine that can lengthen the QT interval;
• are pregnant or breastfeeding.

Check with your doctor first if

• you are an older adult;
• you have epilepsy or a high risk of seizures;
• you have glaucoma, trouble passing urine, slow bowels, myasthenia gravis or dementia;
• you have liver or kidney disease, as the dose may need to be lower;
• you have an allergy test booked. Atarax should be stopped at least 5 days before it.

Can I drink alcohol or take other sedatives with Atarax?

No. Avoid alcohol while you take it. Alcohol, sleeping pills, strong painkillers and other sedating medicines add to the drowsiness. Tell your doctor about all your medicines. This includes some antidepressants, antipsychotics, antibiotics, antifungals, malaria medicines, heart rhythm medicines and methadone, as some of these affect the QT interval.

Can I drive on Atarax?

Not until you know how it affects you. It can cause drowsiness, slow your reactions and reduce your attention. This is most likely at the start, or when the dose goes up.

Can I take Atarax when pregnant or breastfeeding?

No. It must not be used in pregnancy. Babies exposed near birth have had problems such as weak or stiff muscles, shaking and trouble passing urine. It must not be used when breastfeeding either. If treatment is truly needed, breastfeeding has to stop.

What are the side effects?

Drowsiness is the most common side effect. Others include headache, tiredness, dry mouth and dizziness. Fits are rare. Heart rhythm problems can also happen; how often is not known. Stop it and get help if you have palpitations, fainting or shortness of breath.

What is it called in the UK and the US?

The medicine is hydroxyzine everywhere. In the US the brand Atarax is no longer sold; the brand still on sale is Vistaril, alongside generic hydroxyzine. In the UK it is mostly prescribed as generic hydroxyzine. In the UK it is prescription-only, as in Spain. Spanish pharmacies ask for a prescription from a doctor licensed in Spain, so a foreign prescription is normally refused.

When to see a doctor

• Your itch lasts more than two weeks, spreads, or keeps you awake.
• Your itch comes with weight loss, night sweats, yellow skin or tiredness.
• Anxiety is affecting your daily life, work or sleep.
• You feel too drowsy or confused while taking it.

When to call 112

• Fainting, a racing or irregular heartbeat, or chest pain.
• Swelling of the face, lips or tongue, or trouble breathing.
• A fit (seizure).
• Someone has taken too much and is very drowsy or hard to wake.

If you have thoughts of suicide, call 024, Spain's free suicide prevention line, or 112 if you are in danger now.

Frequently asked questions about Atarax

Getting a medical assessment

If you have itching or anxiety and want advice, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about causes of itchy skin, eczema and choosing an antihistamine. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.